The applicant and principal investigator (PI) is a board-certified cardiologist, Assistant Professor of Medicine and Senior Associate Consultant in the Mayo Clinic Cardiovascular Division. [The long-term goal of the PI is to become an independent clinician-investigator in translational informatics focused on the development, validation and deployment of electronic tools to the point-of-care to improve outcomes for patients with cardiovascular disease. The PI intends to leverage the EHR to conduct population-based studies using electronic algorithms that include NLP and by application of state-of-the-art informatics approaches to deliver the knowledge at the point-of-care in support of patient-centered decision-making for patients with peripheral arterial disease (PAD). The electronic tools developed will be portable to different institutions and other health conditions. The PI will be uniquely positioned as a cardiologist within a large academic health system working with novel NLP techniques at the interface of the EHR and CDS to rapidly translate knowledge acquired in community-based epidemiologic investigations to patient care.] The PI has proposed a research career development plan to acquire expertise in translational informatics including electronic phenotyping, and automated calculation and visual display of prognostic scores using a novel application integrated with clinical decision support (CDS). The PI will complete comprehensive coursework in informatics science and gain additional patient-oriented and epidemiologic research experience. The primary mentor will be Iftikhar Kullo, M.D., cardiologist and PI of the Mayo Clinic electronic MEdical Records and GEnomics (eMERGE) network and a leader in the development and application of electronic phenotyping for genomic studies of PAD. The mentoring team also includes Dr. Christopher Chute, M.D., Head of Medical Informatics at Mayo Clinic, an expert in informatics and epidemiology, and co-PI of the Mayo eMERGE grant and co-investigator of the Rochester Epidemiology Project; Hongfang Liu, Ph.D., an expert in natural language processing (NLP) and its application for EHR-based phenotyping; and Kent Bailey, Ph.D., senior biostatistician with expertise in development of prognostic risk scores. The specific aims of the proposal are: Aim 1 - Apply phenotyping algorithms that include NLP of clinical notes to [a] identify PAD cases and controls without PAD in the community from 1998-2011; and [b] ascertain adverse cardiovascular and limb outcomes through December 2013. Aim 2 - Create multivariable prognostic risk models and scores for adverse outcomes in PAD cases from the community. We will estimate the relative risk of death in PAD patients compared to controls without PAD. Aim 3 - Develop and evaluate usefulness of a novel electronic application within the Mayo EHR to retrieve relevant data elements, calculate, and display individualized prognostic scores. On completion of the proposed investigations the deliverables will be new knowledge and an e-health prognostication tool for PAD patients to be disseminated to stakeholders including clinicians, patients, and researchers portable to other institutions and other cardiovascular diseases.